Reply to: “In Support of Electronic Versions of Movement Disorder Society Rating Scales”

We appreciate the reply of Drs. Fuller, Sanchez-Ferro, Goetz, Martinez-Martin, and Stebbins, “In Support of Electronic Versions of MDS Rating Scales,”¹ in response to our letter “Inconsistent Movement Disorder Society-United Parkinson’s Disease Rating Scale Part III Ratings in the Parkinson’s Progression Marker Initiative.”² The authors describe the MDS Rating Scales Program’s current efforts to create and review electronic versions (e-versions) of MDS-owned rating scales, including the potential for algorithmic correction of inconsistencies during scale completion.

In addition to catching data entry errors, algorithms to identify unusual rating combinations or changes between visits may also prove useful in flagging cases that may not represent idiopathic Parkinson’s disease (eg, functional movement disorder or vascular parkinsonism). Similarly, raters could be alerted to unusual patient responses to parts I and II that might suggest atypical parkinsonism; for instance, in PPMI, fewer than 1% of newly diagnosed PD participants rated item 1.11, “Urinary problems,” greater than 3 or 1.12, “Lightheadedness,” greater than 2 at baseline. Of course, such flags would vary according to the population of interest. Finally, cross-checking ratings between parts I through IV seems worthwhile (eg, correspondence between patient rating on 2.12, “Walking and Balance,” and clinician rating on 3.10, “Gait”).

A collaborative effort among groups using the MDS-UPDRS may be the most effective means of capturing the full spectrum of PD progression and achieving the aims described in the response letter and expounded on above. In conclusion, we are most pleased to hear that the MDS is developing electronic data capture tools to enhance signal detection in PD research and eager to see the results of future validation studies.